"Switching health insurance" covers three different moves in Germany, each with its own rules. Changing public fund takes a form and a notice period. Going private is open only to some people, and only at certain moments. Going back from private to public is the hard one — and from 55 it is generally closed.
1. Moving between public funds
The benefits of the public funds (Krankenkassen) are largely fixed by law, so they differ mainly on price. Every fund charges the same general rate — 14.6% of pay for employees, split with the employer (§ 241 SGB V) — plus its own additional contribution (Zusatzbeitrag). Beyond that, funds differ in extras written into their statutes, bonus schemes and service. A fund open to you must accept you, whatever your health.
The rules for moving (§ 175 SGB V):
- Minimum membership. You are tied to a fund for at least 12 months, though a switch can be arranged in advance to take effect as they end.
- Notice. The old membership ends at the end of the second month after the month in which you join the new fund. Join in May, and the old membership ends on 31 July; the new one starts on 1 August.
- Paperwork. You do not cancel anything yourself. You join the new fund, it notifies the old one electronically, and the old fund confirms the end date within two weeks. Employees tell their employer which fund they now belong to.
- A new job resets the choice. Employees who change employer can pick a fund without waiting out the 12 months, and have two weeks from starting to tell the new employer.
- Optional tariffs (Wahltarife) — a deductible, a premium refund, extra sick pay — tie you to the fund for one or three years, depending on the tariff (§ 53(8) SGB V).
2. When your fund raises its Zusatzbeitrag
A rise in the additional contribution gives you a special right to leave, even inside the first 12 months. You can switch up to the end of the month in which the higher rate is first charged; the normal notice period then runs, and you pay the higher rate until it ends. If a rise applies from 1 January, joining another fund by 31 January moves you there from 1 April (§ 175(4) SGB V).
Since 30 July 2026, funds no longer have to write to each member about a rise — a 2026 reform removed that duty. The right to leave remains, but spotting the rise is now up to you. The GKV-Spitzenverband, the national association of the public funds, publishes a continuously updated list of every fund's rate. The official average additional contribution for 2026 is 2.9% (Federal Ministry of Health); it is set every autumn, and a fund can also raise its rate during the year.
One exception: a member in an optional sick-pay tariff stays tied for the full three years, rise or no rise, save in cases of hardship (§ 53(8) SGB V).
3. From public to private
Employees can leave public insurance only if they earn above the annual income threshold (Jahresarbeitsentgeltgrenze). For 2026 it is €77,400 a year (€6,450 a month, § 2 SVBezGrV 2026), and it is adjusted every year. Compulsory insurance ends at the end of the calendar year in which your regular pay exceeds it — provided the pay also exceeds the threshold for the following year (§ 6(4) SGB V). Someone starting a new job with pay above the threshold is free from the first day.
Being free is not the same as having left. When compulsory insurance ends, membership carries on as voluntary membership unless you declare your exit within two weeks of the fund's notice and prove you have other cover (§ 188(4) SGB V). The self-employed can generally choose; a voluntary member who leaves for private cover is not held to the 12-month minimum, but the notice period applies, and the exit takes effect only if you prove the new cover before it ends (§ 175(4) SGB V).
For 2027, a 2026 reform raises the threshold by an extra €3,600 on top of the usual annual adjustment, a step that then stays in it. Employees already privately insured at the end of 2026 because their pay was above the threshold are measured against a separate threshold without that extra step.
On the private side, the premium follows your age, your health and the benefits you choose, not your income (§ 203 VVG). Applications come with health questions, and an insurer can add a surcharge, exclude conditions or decline a normal tariff.
4. Changing tariff with your private insurer
Private premiums rise with age and medical costs, and the main lever sits inside your own insurer. Under § 204 VVG you have a right to move to any of its other tariffs with the same kind of cover, keeping the rights you have built up and your ageing reserve (Alterungsrückstellung — the savings built into your premiums to cushion them in old age). A move to cover that is the same or lower needs no new health check. When a letter raises your premium, what it must say and your special right to cancel are in what to do about a private premium increase.
If the new tariff pays for more than the old one, the insurer may ask for a surcharge, a waiting period or an exclusion — but only for the extra benefits, and you can avoid the surcharge and the waiting period by agreeing to go without them. The right cannot be signed away. A premium increase also gives you a right to cancel — but, as the next section explains, only into new cover.
5. Why a new private insurer can cost you
Moving to another private insurer is a fresh start in the wrong ways. The new insurer prices you at your current age and asks the health questions again, so anything diagnosed since you first signed can mean a surcharge or an exclusion.
The ageing reserve only partly follows you. For contracts taken out since 2009, the part that corresponds to the basic tariff (Basistarif — a regulated tariff with benefits similar to public insurance) moves to the new insurer, and the rest stays with the old one. For older contracts, nothing moves. And a private policy cannot simply be ended: the cancellation takes effect only when you prove that new cover starts without a gap (§ 205 VVG).
6. Getting back into public insurance
There is no switching back on request. The way in is to become compulsorily insured again, or to qualify for family insurance:
- Employment below the threshold makes you compulsorily insured (§ 5 SGB V).
- Unemployment benefit (Arbeitslosengeld) generally brings public insurance with it.
- Family insurance through a publicly insured spouse is possible if your own income stays below the limit — €565 a month in 2026 — and self-employment is not your main occupation (§ 10 SGB V).
When compulsory insurance starts, you can cancel the private policy retroactively within three months (§ 205(2) VVG). The self-employed generally have no route back while they stay self-employed — our guide to health insurance for freelancers looks at that choice before it is made.
From age 55, compulsory insurance generally stops being a way back. Someone who becomes compulsorily insured after 55 stays outside the public system if they had no public insurance in the previous five years and spent at least half of that time free of compulsory insurance (above the threshold, for example, or as a civil servant), exempted from it or self-employed (§ 6(3a) SGB V); being married to, or in a civil partnership with, such a person meets the half-the-time condition too. The age rule does not apply to family insurance, but its income limit is low.
7. Families
In public insurance, a spouse and children with little or no income of their own are covered through the member. A 2026 reform changes part of this from 2028: members will pay a surcharge of 2.5 percentage points for a family-insured spouse, unless an exception applies — for example a child under 12 in the household, caring for a relative, or reaching pension age. In private insurance, every person has a premium of their own. Who qualifies, the income limit and the children's age limits are in our guide to family insurance.
Mixed couples meet one more rule. If the parents are married and the privately insured parent has a higher income than the publicly insured one and above the threshold, the children cannot be covered free through the public parent (§ 10(3) SGB V). Our money checklist for a new baby covers what that means when a child arrives.
The short version
Between public funds the rules are simple: twelve months' minimum, then notice to the end of the second following month, and an earlier exit whenever your fund raises its additional contribution — a rise you now have to spot yourself. Employees can go private only above €77,400 in 2026. Inside a private insurer, § 204 VVG lets you change tariff and keep your ageing reserve; moving to another insurer means new health questions and leaving much of that reserve behind. Coming back to public insurance needs a legal route, and from 55 compulsory insurance generally no longer provides one.
Primary sources checked on 15 October 2026: the statutes and official pages linked above.